Periventricular-intraventricular cerebral hemorrhage (IVH) remains a significant problem of the very low birth weight infant and is associated with a mortality of up to 40% and a morbidity approaching 80%. Recently surfactant replacement therapy has become universal for premature infants with Respiratory Distress Syndrome (RDS). While improving immediate pulmonary function, the incidence of IVH has remained the same and there is an increased incidence of pulmonary haemorrhagia (PH). The hypothesis of this study is that early onset IVH and PH in the very low birth weight premature infant is a reperfusion injury which follows a prior ischemic event. Preterm infants who develop IVH and PH will exhibit biochemical alterations consistent with tissue injury as compared to preterm infants who do not develop IVH and PH. The overall objective of this study is to determine biochemical alterations suggestive of tissue injury, that develop in preterm infants who develop IVH and PH.